Hellobee Boards

@Danizaur: The link doesn't seem to be working

wow - that is a lot - What is his yearly OOP???
Mine is only 3k (which I thought was a lot)

I agree that insurance companies should crack down on the hospital fees - some are outrageous!

YEP.

Unreal. That is so scary.

Omg!

Through my NICU adventures I see a lot of this. DS2 was helicoptered for his current stay, I want to see how much the bill is for that! Thankfully our insurance isn't as bad as that guy's.

I actually don't think being sick in America sucks that bad, if you're going to get sick, don't you want to be in a place where you have the ability to go to the hospital in the first place?

Also, our insurance situation is what it is, largely because we (as a country) do not want to pay so much more in income tax. The cost of healthcare is expensive, no matter where you live, it's just a matter of when you pay for it (in your taxes or personally when you get sick).

@looch: Yeah, I don't think people realize how much more taxes we pay in Canada. We pay for our healthcare here too. Nevermind that I have quite a few problems with the care myself and family has received. I don't know what the best system would be, but I would definitely say that Canada doesn't have it perfect either.

I think this is actually evidence of a fairly reasonable insurance contract. His bill was $55k, and insurance paid some $44k or so of that, so 80%. Now, $11k is still a big number, but he had a nontrivial operation. And presumably when he signed his insurance contract, he read all the fine print about out-of-pocket expenses and in-network providers, right? So why is that 80/20 split objectionable? (And if it is objectionable, then consider that the vast majority of the plans available on the individual market under the ACA are much less favorable to insureds.) I think it's really important to remember that insurance should not be a prepayment plan for healthcare services. It's a financial product that protects you against financial ruin in the event of a catastrophe. This guy had a catastrophic event, and his insurance picked up the bulk of the bill. The only problem I see here is that he had no idea what an appendectomy cost in his area when he was deciding to buy that 80/20 insurance plan, because there is next to no transparency in the healthcare industry (a related discussion).

@sunny: I think you're right. I have read that the Sutter Health system has a virtual monopoly on the healthcare market in that area (San Fran/Sacramento). They therefore have close to monopoly prices. That isn't the case in a lot of the rest of the country.

I'm surprised by this - my OOP max for my insurance is $3k, so I'd never have to pay this much. I'm not sure why his insurance has such a high OOP max, but I definitely disagree that it sucks to be sick in America!

@honeybear: I agree, his insurance paid 80%, which is pretty standard!

I'm not positive, but I think a lot of hospitals are non-profit and have a TON of overhead, plus the coverage for everyone that doesn't have insurance or can't afford to pay. You'll notice on his bill, that the allowance by the insurance was reduced by $37k. I believe that means that even though the hospital tried to charge $55k, they were actually only going to be paid $18k.

@SweetMamaM: Yes. There is a lot of good info out there that many people below the poverty line do not have regular health care (checkups, preventative care, etc.) and do not seek help when they are sick, compared to those with health insurance. Many without healthcare utilize the ER as their main healthcare contact, which is the absolute most expensive and least effective way to use healthcare – both for the patient (if they pay the bill; if they don’t their credit is often ruined in the process), the hospital and the rest of the taxpayers.

@yoursilverlining: awww that's sad. We have a lot of local clinics in areas that have been targeted as at-risk...quite a few of them are attached to schools or marae (Maori community hubs) but service whole families at little or no cost. It's hoped that it will reduce the incidences of rheumatic fever within impoverished and minority communities. We're also very lucky that health care is completely free (not even a subsidized consult fee) for children under the age of six so that means that those check-ups, vaccinations and preventative medicine matters actually happen.

More to the point, the cost of services is outrageous, which I believe is the point of his posting his bill. DH was in the hospital for 10 days a year ago, had a more invasive surgery than this guy and in total his bill was $55k before insurance.

Trying to navigate the healthcare system in this country is ridiculous. One doctor group charged us more than $1000 when all they did is come into the room and ask how he was doing. We had to pay that out of pocket because that group of doctors wasn't in our network, yet worked at the hospital that was in our network, that was the case with the anesthesiologist and a few other doctors as well. Now I worry any time there is an emergency situation that pops up I will have to be on my phone trying to figure out who is covered and who isn't instead of focusing on the emergency itself. It's a nightmare.

@looch: That's not entirely true. Yes you're always going to pay for healthcare one way or another (taxes or privately), but the cost of care is higher in America than in most places, and we get less for it.

Excellent video: http://www.upworthy.com/his-first-4-sentences-are-interesting-the-5th-blew-my-mind-and-made-me-a-little-sick-2

@Mae: The video is blocked for me at work, I'll try to remember to watch it later at home, so thanks for that!

I have lived in 2 countries and paid for insurance in both places. For a family of 3 we paid MORE in Switzerland for the same amount of coverage. The main difference is that there, the government mandates that everyone be covered, so the insurance companies have levels of coverage available at different income levels. Your employer pays nothing, so the cost is more as a result.

I had collegues in Singapore that paid nothing for medical coverage, because the governement requires that companies that want to do business there pay for coverage for their employees.

Just to give numbers, we paid the equivalent of about $600 for coverage for a family of 3 abroad, in the US, the equivalent coverage is about $400, with our employer paying part.